Do joint mobilizations assist in the recovery of lateral elbow tendinopathy? A systematic review and meta-analysis

J Hand Ther. 2019 Apr-Jun;32(2):262-276.e1. doi: 10.1016/j.jht.2018.01.010. Epub 2018 Apr 26.


Study design: Systematic review.

Introduction: No consensus exists as to which are the most effective methods to treat the symptoms associated with lateral elbow tendinopathy (LET). Research has suggested that joint mobilizations may assist in the recovery of patients with LET.

Purpose of the study: To determine if joint mobilizations are effective in improving pain, grip strength, and disability in adults with LET.

Methods: Searches in 3 databases were performed to identify relevant clinical trials. Reviewers independently extracted data and assessed the methodological quality. Summary measures of quantitative data were extracted or calculated where possible. Appropriate data were pooled for meta-analysis using a random-effects model.

Results: A total of 20 studies met the inclusion criteria; 7 were included in the meta-analysis. Studies were broadly classified into 3 groups: mobilization with movement (MWM), Mill's manipulation, and regional mobilization techniques. Pooled data across all time periods demonstrated a mean effect size of 0.43 (95% confidence interval [CI]: 0.15-0.71) for MWM on improving pain rating, and 0.31 (95% CI: 0.11-0.51) for MWM on improving grip strength, 0.47 (95% CI: 0.11-0.82) for Mill's manipulation on improving pain rating. A mean effect size of -0.01 (95% CI: -0.27 to -0.26) shows Mill's manipulation did not improve pain free grip strength. Functional outcomes varied considerably among studies. Pain, grip strength, and functional outcomes were improved with regional mobilizations.

Conclusion: There is compelling evidence that joint mobilizations have a positive effect on both pain and/or functional grip scores across all time frames compared to control groups in the management of LET.

Keywords: Elbow pain; Joint mobilization; Lateral epicondylitis; Manual therapy.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Elbow Tendinopathy / therapy*
  • Hand Strength
  • Humans
  • Manipulation, Orthopedic*
  • Pain Measurement